The Doctor Shortage – Where are all the Doctors?

We’re living longer these days. Our country’s population is steadily growing. And, with the passage of 2010’s Affordable Care Act, health insurance is increasingly available to Americans. While all of these facts are positive, there is a potentially concerning factor we must consider as a result: An impending shortage in family doctors.

Most of us value the relationships we develop with our primary care physicians, but in order to maintain this status quo for an expanding and longer-living population, we’re going to need a lot more doctors in a few short years.

The figure of 52,000 represents a 3% increase to our current pool of primary physicians. Let’s see how that’s broken up:

Researchers predict there will be about 100 million more doctor’s office visits in 2025 (growing from 2008’s ballpark of 462 million). The 3% increase is the estimated percentage needed to cover these extra visits.

Out of the 52,000 new doctors needed, 33,000 are necessary to account for population growth, 10,000 for the aging population, and around 8,000 to cover increased health insurance access.

The issue lies in the specialties these doctors choose. Although an increased number of MDs in all areas will be needed to fill demand in coming years, the specialty of primary care is taking a particular hit. Fewer and fewer medical graduates are choosing primary care as a specialty. A 2008 study shows that over a five-year period (2002-2007), the number of primary care physicians dropped by nearly 27%.

There are several potential reasons for this. A likely large factor is compensation: Primary care physicians have long been tagged as the lowest-paid specialty, making anywhere from $100-300K less annually than their colleagues in higher-paid specialties such as cardiology or radiology.

Unfortunately, this salary discrepancy can also lead to a feeling of lesser respect for the specialty overall. And, as anyone knows, medical school bills are astronomically high–and need to be paid off!

Add all of these factors together and it’s no shock that it is becoming increasingly difficult to talk medical students into choosing primary care.

The Affordable Care Act includes some provisions (including financial incentives) to encourage medical students into the specialty, but projected expectations of how many new primary care doctors it will produce are low–only about 500 a year.

What can be done?

In order to both streamline existing primary care practices, as well as smooth the path for those entering the specialty, there are several ideas that have been brought up to handle the strain of increased patient demand in the future.

A major plan proposed is an essential reshaping of primary care, in which nurse practitioners and physician assistants handle routine patient concerns. This frees up the physician to focus on more serious cases. Additionally, these professionals require less time in school (a master’s degree) while still having the advantage of specialized training, allowing potentially more individuals to enter the fields.

There’s also the time-tested incentive of plain old money. For example, a key provision of the Affordable Care Act is a 10% bonus to primary care doctors who offer services to the increasing number of patients on Medicare.

Will such actions be enough to combat the rising doctor’s shortage in the next decade? Reports are both optimistic and pessimistic, but it is important to look—and plan—ahead for a future that appears to contain a complete sea change in health care.